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Program Details

PFIZER, INC.
Pfizer Savings Program

Glyset (miglitol)
 
CONTACT INFO
Address: PO Box 66585
St. Louis, MO 63166-6585
Phone: 1-866-706-2400 Provider Phone:
Fax: 1-866-470-1748 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Call program for prescreening. There is no application form; patients enroll on the phone.
  • Patient must be uninsured.
  • Medicare Part D patients are not eligible.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: No
    US citizenship/residency specified: No
    APPLICATION
    Attachments Required: None
    Physician License #
    Required:
    Not Required
    Prescriber Signature
    Allowed:
    Not Required
    Application may be
    faxed:
    Not Published
    Eligibility determination
    letter sent:
    Not Published
    Decision made during phone screening
    MEDICATION
    Receives: Medication
    Shipped To: None
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New enrollment every 12 months
    Refill Policy: Varies by medication
    Other Information:
  • This program provides uninsured patients with prescription savings at the pharmacy.
  • Pfizer also has programs that provide eligible patients with insurance support, copay assistance, and medicines for free. Contact Pfizer RxPathways at 1-844-989-7284 for more information.
  • Last Updated: 12/05/2018

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.



     

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